Cytokine kinetics profiling in pediatric renal transplant recipients

Niederhaus SV, Bloom DD, Chang Z, Hu H, Bartosh SM, Knechtle SJ. Cytokine kinetics profiling in pediatric renal transplant recipients. Pediatr Transplantation 2010: 14:636–645. © 2010 John Wiley & Sons A/S. : Pediatric renal transplant recipients experience side effects of immunosuppression. Few immunoassays exist which can assess the adequacy of immunosuppression. We developed a CKT, whereby cytokine levels are measured in a five‐day mixed lymphocyte reaction. We describe the in vitro cytokine responses to donor and third‐party antigen in a pilot study of nine children after living‐donor renal transplantation. The CKT identified five patterns of IFN‐γ secretion relative to donor and third‐party alloantigen: no response to alloantigen (n = 2), hypo‐response to donor (n = 3), equal response (n = 1), hyper‐response to donor (n = 1), and intermediate response (n = 2). IL‐2 and IL‐13 patterning correlated with IFN‐γ expression. Two of nine subjects had acute rejection, which correlated with intermediate and hyper‐responsive profiles. No rejection occurred during immunosuppression or donor‐specific hypo‐responsiveness. Significant immunosuppression was universal early after transplantation. Two of four children showed strong pretransplant responses to donor, which were regained three months post‐transplant, and associated with rejection in one subject. The CKT reflects the level of immunosuppression and may offer a method to assess the adequacy of immunosuppression. A pattern of complete non‐responsiveness or hypo‐responsiveness correlated with lack of acute rejection. The CKT may prove useful in titrating immunosuppression and in improving live donor selection.